Cornea Cases

Title:

Long-term massive and continuous flattening after corneal cross-linking

Case Report Details

First Author: E.Torres-Netto SWITZERLAND

Co Author(s):    H. Abdshahzadeh   R. Abrishamchi   F. Gilardoni   C. Villalobos   N. Hafezi   F. Hafezi     

Abstract Details

Purpose:

To report a case of massive and continuous flattening after 10-years following corneal cross-linking (CXL) for keratoconus treatment.

Setting:

The ELZA Institute, Zurich/Dietikon (Switzerland) and Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine at the University of Zurich (Switzerland).

Report of case or case series:

A 46 year-old female patient underwent bilateral standard CXL (3 mW/cm2 for 30 minutes and total energy of 5.4 J/cm2) due to progressive keratoconus in 2008. Ten years later, Scheimpflug’s differential image map shows a very unusually massive flattening of the anterior curvature of up to 17 diopters.

Conclusions/Take Home Message:

At the moment there is no evidence as to when progressive flattening may still evolve, especially considering that the published series show results up to 10 years of CXL post-operative follow-up. Interestingly, there are hypotheses that the time of collagen turnover would be a possible limiter of the long-term effect of CXL. Despite this, the present clinical report demonstrates corneal flattening can continue to progress even after long-term after CXL. This suggests not only the continuous monitoring of these patients, but also that the understanding of the CXL mechanism should be further elucidated.